Provider Demographics
NPI:1497030597
Name:SHAW, JOSEPH A (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:SHAW
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 MESA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4418
Mailing Address - Country:US
Mailing Address - Phone:214-923-7952
Mailing Address - Fax:
Practice Address - Street 1:12700 HILLCREST RD
Practice Address - Street 2:SUITE 250
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2033
Practice Address - Country:US
Practice Address - Phone:214-923-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63384101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional